Long-term trends in hepatitis C prevalence, treatment uptake and liver-related events in the Swiss HIV Cohort Study. Liver International
Baumann et al. assessed trends in the prevalence of replicating hepatitis C virus (HCV) infection, the uptake of HCV treatment, and its impact on liver-related morbidity and mortality among people with HIV (PWH) and HCV in the Swiss HIV Cohort Study (SHCS).
The study included all participants with follow-up after January 2002, when HCV-PCR became broadly available in clinical routine. Replicating HCV infection was defined as at least one HCV-RNA measurement >50 IU/mL, and HCV treatments included interferon (with or without ribavirin), first-generation direct acting antivirals (DAA; telaprevir, boceprevir, and faldaprevir), and second-generation DAAs (sofosbuvir, daclatasvir, velpatasvir, glecaprevir/pibrentasvir, and others).
The study included 14’652 participants, of which 2’294 individuals had at least one detectable HCV-RNA measurement. Compared to individuals with HIV mono-infection, those with HIV/HCV coinfection were younger, more likely to be Caucasian, and more likely to have acquired HIV through injection drug use. The yearly prevalence of replicating HCV infection among all SHCS participants was highest in 2004 (16.5%), and declined to 1.3% in 2021. HCV treatment uptake rapidly increased with the availability of second-generation DAAs: In 2014, 6.7% of individuals with replicating infection received treatment, compared to 32.6% of people with active HIV/HCV coinfection in 2016. Among the 2’294 persons with replicating HCV infection, overall mortality declined from a maximum of 3.3 per 100 patient-years (PY) to 1.1 per 100 PY, and incidence of liver-related events decreased from 1.4/100 PY to 0.2/100 PY.
In summary, the study showed that the widespread adoption of second-generation DAAs led to a substantial decline in HCV infections among PWH in Switzerland, with prevalence estimates now approaching that from the general population. The reduction in HCV burden was followed by lower rates of mortality and liver-related events, highlighting the considerable success of therapeutic interventions towards eliminating HCV among PWH.